05D1069365 CLIA NUMBER - SAN BERNARDINO VALLEY COMMUNITY COLLEGE STUDENT HEALTH SERVICES

Laboratory Demographics

CLIA Number: 05D1069365

Facility Name: SAN BERNARDINO VALLEY COMMUNITY COLLEGE STUDENT HEALTH SERVICES

Facility Address:
701 SOUTH MT VERNON AVE
SAN BERNARDINO, CA
ZIP 92410
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Facility Phone Number: 909 384-4495

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1407189525

Taxonomy: 261QS1000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1069365
LAB Type	School/Student Health Service
Facility Name	SAN BERNARDINO VALLEY COMMUNITY COLLEGE STUDENT HEALTH SERVICES
Street	701 SOUTH MT VERNON AVE
City	SAN BERNARDINO
State	CA
ZIP	92410
Phone	909 384-4495
CertificateType	4
CertificateEffectiveDate	6/4/2023
CertificateExpirationDate	6/3/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024